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Friday, July 12, 2019


Trump Administration Drops Rebate Plan


On July 11, 2019, the Trump administration announced that it will not be moving forward on a proposed rule to eliminate arcane rebates that flow from drug manufacturers to the PBMs (Pharmacy Benefit Managers). Many employers were concerned that this ruling would have a trickle down effect and conceivably mandate that they also would be required to provide rebates for certain drugs to certain members at Point of Sale. That concern is now alleviated.

The draft measure, which was projected to raise federal spending by $177 billion over the next decade, was poised to prohibit drug rebates for treatments offered in the Medicare and Medicaid programs beginning in 2020. This drew intense backlash from the PBMs, whose operations would be significantly impacted by this action. It also drew praise from drug companies that routinely blame PBMs as the cause of the high cost of drugs.

Top PBMs, like CVS Health, warned that removing the rebates would lead to higher drug costs for seniors, an outcome that sources say the White House was concerned about before the 2020 elections.

In another blow to the pharmaceutical industry, Trump is weighing an executive order to tie prices for Medicare Part B drugs to the lowest cost available internationally, an action that would undermine profits in the sector.

Monday, April 22, 2019


PBIRx has a New Look!

We’re still the same company, but we have updated our materials to better communicate who we are and how our products and services support your quest for better and more affordable pharmacy benefit plans!   

Data and creative cost savings solutions require “very specialized thinking” and we are proud and fortunate of the team we employ with their varied expertise, intelligence, and longevity in the industry and with PBIRx.








Bold letter forms represent our confidence and tenacity in everything we do.

The Brain represents our capacity to combine our comprehensive and analytical understanding of pharmacy benefits.  Our recommendations are based on right-brain/left-brain thinking.


The Tablets represent our focus on medications, formularies and clinical recommendation that provide better member benefit and health outcomes.

The Gradient Colors represent the dynamic, fast changing healthcare landscape.

PBI stands for Pharmacy Benefit Intelligence, which is what we live and what we deliver.

Our focus continues to be on our clients.  We evaluate current drug usage and spend, claim by claim, and then model and present alternative opportunities customized for each client which can yield measurable plan and member savings enhancing benefits while delivering optimum health outcomes.


PBIRx® has been exclusively providing intelligent solutions to clients in the management of pharmacy benefit costs since 1993. With a staff that includes IT personnel, actuaries, financial analysts, clinical pharmacists, attorneys, HIPAA Compliance Officers and many more experts, PBIRx’s mission is to create optimal healthcare outcomes while minimizing overall healthcare costs. For more information, please visit www.pbirx.com or call (888) 797-2479.



Wednesday, April 17, 2019

Two New Drugs for Multiple Sclerosis


Two New Drugs for Multiple Sclerosis

The FDA has recently approved two new oral drugs for the treatment of Multiple Sclerosis (MS).
Over the last few years, three oral drugs for MS have become available: Gilenya came to the US market in 2010; Aubagio was released in 2012; and Tecfidera in 2013. Prior to that, all therapies were injectables.

Mavenclad (cladribine), an oral form of an older drug, given intravenously for certain types of leukemia, was FDA approved for the treatment of relapsing forms of MS  including active secondary progressive disease in adults. As a result of its safety profile, it’s generally recommended for patients who have had an inadequate response to, or are unable to tolerate, an alternate drug indicated for the treatment of MS. Treatment with Mavenclad may increase the risk of malignancy.

Uniquely, Mavenclad is only administered twice over four or five days, for two treatment courses which are spaced about a year apart. After that, the patient doesn’t receive any medication for at least two years. The dose is weight-based; the total annual cost for an average 80kg person (176 lbs) is $127,900. Though it’s given much less frequently than any of the other currently available monthly oral medications, it is more expensive per month ($10,661).

Mayzent (siponimod), was approved for the same indication. The dose is also unusual: 0.25 mg once daily on Days 1 and 2; 0.5 mg once daily on Day 3; 0.75 mg once daily on Day 4; 1.25 mg once daily on Day 5. The maintenance dose is 2 mg once daily beginning on Day 6. The monthly cost is $8,729.

Only time will tell how these two new drugs will perform in the Multiple Sclerosis landscape.




PBIRx has been exclusively providing intelligent solutions to clients in the management of pharmacy benefit costs since 1993. With a staff that includes IT personnel, actuaries, financial analysts, clinical pharmacists, attorneys, HIPAA Compliance Officers and many more experts, PBIRx’s mission is to create optimal healthcare outcomes while minimizing overall healthcare costs. For more information, please visit www.pbirx.com or call (888) 797-2479.

Wednesday, March 27, 2019

Purdue Pharma to Pay $270 Million in Historic Lawsuit

Purdue Pharma has reached a settlement with the State of Oklahoma over claims the maker of the painkiller OxyContin helped fuel an opioid epidemic that killed thousands of residents in the state.  

Of the $270 million, nearly $200 million will go toward establishing the National Center for Addiction Studies and Treatment at Oklahoma State University in Tulsa, while local governments will receive $12.5 million.  Twenty million dollars will be set aside for addiction treatment medication, and the remaining $60 million will pay for the state's litigation costs to date.

Purdue, the make of OxyContin since 1996, faces more than 1,000 lawsuits in connection with the opioid crisis.  The Oklahoma deal is the first settlement to emerge from the thicket of lawsuits.

Drugs like OxyContin, along with illegal opioids such as heroin, were linked to a record 48,000 deaths across the United States in 2017 according to the CDC.  In Oklahoma, some 400 deaths were related to opioids that year.  According to state figures, more Oklahomans have died from opioids over the last decade than vehicle accidents.

Purdue Pharma is reportedly considering bankruptcy.



PBIRx has been exclusively providing intelligent solutions to clients in the management of pharmacy benefit costs since 1993. With a staff that includes IT personnel, actuaries, financial analysts, clinical pharmacists, attorneys, HIPAA Compliance Officers and many more experts, PBIRx’s mission is to create optimal healthcare outcomes while minimizing overall healthcare costs. For more information, please visit www.pbirx.com or call (888) 797-2479.